A Case of Posterolateral Corner Injury with Segond Fracture in Association with Anterior Cruciate Ligament Tear on MRI - A Case Report

Knee injuries are common in sports and depending on the mechanism of fall, injury of different ligaments can occur. Knee injury mostly involves the anterior cruciate ligament (ACL), and is the most common injury reported on MRI. It can be associated with posterolateral corner (PLC) injury and other osseous injuries, these injuries are rarely reported as they are very complex in structure. A detail knowledge about this complex helps to evaluate the associated ligaments as well. In association with anterior cruciate ligament injuries presence of a Segond fracture indicates occurrence of a concomitant or isolated injury to the posterolateral corner injury. The evaluation of these associated injuries along with anterior cruciate ligament aids in their repair and hence improving the postoperative outcome. Three main components of posterolateral corner are divided into three layers – superficial, middle, and deep. Clinically few tests have been advised to evaluate injury of different structures of knee joint. For example - McMurray's test and Ege's test are used to evaluate meniscus, Lachman test, Anterior drawer test and Pivot Shift Test are performed to evaluate anterior cruciate ligament tear while posterior drawer test is done to evaluate posterior cruciate ligament tear. Availability of special closely coupled extremity coils, high field systems, open system & extremity units have made MRI supplemental to clinical examination and plain radiographs for virtually all suspected disorders of knee. Here, we are presenting a case of MRI of knee injury involving posterolateral corner injury with anterior cruciate ligament tear and Segond fracture. Along with anterior cruciate ligament, medial meniscus, other ligaments and osseous injury are associated as well. The other structures responsible for stabilizing the knee joints are posterolateral corner and meniscus, which when involved may need to be treated simultaneously with anterior cruciate ligament tear, for full re stabilization of knee joint. If any associated fracture is present, it has to be treated simultaneously as well.

Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review

Background: Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee. Purpose: To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies. Study Design: Systematic review; Level of evidence, 4. Methods: A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms “posterolateral corner” and “rehabilitation.” All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury. Results: Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%; P < .01). Overall complication rates were highest in the delayed WB group (44%), followed by the immediate and progressive WB groups (25% and 3%, respectively; P < .00001). The delayed WB group was permitted to return to sport at a mean of 10.5 months from the index procedure; the progressive WB group, at 6.0 months; and the immediate WB group, at 9.0 months ( P < .05). Conclusion: This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.